Provider Representative’s Signature. This MUST be an actual signature of the New Jersey provider business owner. THIS MAY NOT BE STAMPED. This person should have liability authority of the business.
Appears in 4 contracts
Samples: Submitter/Provider Relationship Edi Agreement, Electronic Remittance Advice (Era) Edi Agreement, Pre Enrollment Instructions, Pre Enrollment Instructions
Provider Representative’s Signature. This MUST be an actual signature of the New Jersey provider business or pharmacy owner. THIS MAY NOT BE STAMPED. This person should have liability authority of the business.
Appears in 1 contract
Samples: Trading Partner Agreement
